Monitoring blood glucose

Blood glucose readings:

 Let you know what your blood glucose level is at the moment you take it.
 Help you understand the relationship between the food you eat, physical activity, medications and your glucose level.

Home glucose monitoring is done with a glucose meter, a small, portable machine that measures glucose in
blood. Meters come with a lancing device designed to draw a small sample of blood from a fingertip. Once the
sample of blood is placed on a test strip, it is then read by the meter.

(A blood lancet, or simply lancet, is a small medical implement used for capillary blood sampling. A blood-
sampling device, also known as a lancing device, is a reusable instrument equipped with a lancet. It is also most
commonly used by diabetics during blood glucose monitoring.)

Test Tips

 Wash your hands with warm water and soap. Avoid alcohol, as it can dry your skin.
 Set your lancing device at a comfortable depth.
 Replace the lancet each time you use it.
 When testing, use the sides of your fingertips and rotate amongst your fingers.
 Discard your lancet and strips in a sharps-rated container.

Track Results

Monitor blood glucose levels, track them in a diary or blood glucose log. When looking at glucose readings, it is
patterns and trends that are important – not an occasional reading that is out of the ordinary.

With the information from blood glucose patterns, adjustments to food, activity or medications can be made to
ensure achieving a healthy glucose control.

According to the Canadian Diabetes Association 2003 Clinical Practice Guidelines for the prevention and
management of Diabetes Canada, the target range for most individuals is:

2Hrs After a Meal (from the

Before Meals
time you started your meal)
Normal Range of Glucose 4-6 mmol/L 5-8 mmol/L
TARGET 4-7 mmol/L 5-10 mmol/L

It is helpful to test blood glucose at a variety of times during the day, both pre and post meals. It is quite
possible for the morning/pre-breakfast glucose to be in the target range, and your 2 hour post lunch reading to
be high. Patterned glucose readings, such as several pre-supper readings in a week, provide a more complete
picture than one individual reading.

More frequent testing may be necessary if the blood glucose is not well controlled, if hypoglycemia occurs, or
in unusual situations such as travel, illness or exercise.

What affects blood glucose levels?

A RISE in Blood Glucose levels can be caused by:

An increase in the amount and/or type of carbohydrates eaten. Most foods, except fats and meats, contain carbs.
When you eat foods that have a high concentration of carbohydrates per serving, or you have an increased
amount of your usual foods, your blood glucose will rise.

Glucose released by the liver overnight

the body requires glucose 24/7. The liver stores glucose and releases it during the night. With type 2 diabetes,
the liver can sometimes release too much glucose. This explains why glucose may be higher in the morning
than before bed – even if nothing has been eaten.

Illness
Illness can pose problems for people who have diabetes. Illness is a stress on the body that can cause blood
glucose levels to go up. Even a minor illness such as a cold, flu or infection can raise blood glucose level.

Stress
Emotional stress caused by excitement, anger, worry and fear can cause an increase in blood glucose.

Not enough medication

Less medication than normal (a missed dose) or meds being taken are not effective, glucose levels will rise.

A DROP in Blood Glucose levels can be caused by:

Type and amount of food

Delaying or skipping a meal, or having a meal with less carbohydrate than normal.

More activity than usual

An increase in activity can cause blood glucose levels to drop. if starting a new activity, monitor more
frequently to watch for glucose changes.

More medication than usual

When you have more medication than normal (an extra dose for example) blood glucose levels can drop.

If your blood glucose is low - less than 4mmol/L:

 Check glucose. (If you can’t test and you have symptoms, go ahead and treat it).
 Take 15 g of ‘fast acting’ carbohydrate right away, (15 g glucose tablets or 3 tsp. sugar).
 Wait 15 minutes and recheck blood glucose. You should be feeling better.
 If not better, or glucose level is less than 4 mmol/L, repeat 15 g of ‘fast acting’ carbohydrate.

If next meal is more than 1 hour away, eat a snack of a starch and protein (cheese and 6 crackers, half of a
peanut butter or meat sandwich).

If the blood glucose is severely low - less than 2.8 mmol/L and one is conscious:

 Take 20 g of carbohydrate preferably as glucose tablets

 Wait 15 minutes and recheck blood glucose
 If not improving/feeling better, or your glucose level is less than 4 mmol/L repeat 15 g of fasting acting
carbohydrate

Medications
 TAKING PILLS FOR DIABETES

Pills are prescribed when physical activity and meal planning no longer keep blood glucose levels in a
healthy range. Even if pills are prescribed, meal planning and physical activity are important in diabetes
management.

Diabetes pills are divided into 2 groups: meds to increase the amount of insulin in the body, and meds
to help insulin work better.

Blood glucose results will help the physician decide when medications are required, and what type of
medication will work best. Different medications have different times of the day they should be taken to
have the best effect.

Mind your medications

 Diabetes pills may cause problems with other medications being taken.
 Monitor blood glucose levels carefully to make sure pills are working effectively.
 Drinking alcohol when taking diabetes pills may affect your diabetes control.
 Some diabetes pills can make skin more sun sensitive.

Things you should know about insulin

Prior to diagnosis of diabetes, the pancreas produced just enough insulin to match the rise in your
blood glucose at each meal, and meet your needs between meals and overnight.

With type 1, your body does not produce any insulin. As a result, insulin is taken every day.

With type 2, the body produces insulin, but not quite enough, or insulin is not working very well.

Although pills are often the first choice when medications are required, insulin is quickly gaining favour
as an effective treatment early in the management of type 2 diabetes. Insulin can be used together with
pills, or on its own.

INSULIN
 Use a new cartridge or vial. Remember; always check the expiration date to be sure you can finish
using it in time. Out of date insulin can lose its strength.
 Carry a form of fast acting glucose at all times in case of hypoglycemia

DOSE
 Insulin is measured in UNITS.
 Insulin syringes are marked off in UNITS,
 An insulin pen is a convenient way to take insulin. Dial up dose and deliver by pressing a button

Knowledge and Application Questions:

1. What do blood glucose readings do?

2. Why is it important to track results?
3. When are pills prescribed for diabetes?
4. Why is it important to vary the times when blood glucose is being checked?
5. What can cause a rise in blood glucose?
6. How are diabetes medications divided?
7. What can cause a drop in blood glucose?
8. What are target ranges for blood glucose?
9. What types of medications are available for diabetes? What do they do?
10. When is blood glucose delivered by the liver?